Improving sensitivity of cervical cytology by removal of cervical secretions before sampling: a prospective study in Mexico

Sensitivity of cervical cytology is suboptimal, especially in developing countries such as Mexico, despite available guidelines aimed at improving this. When obtaining cervical samples, whether the samples are taken from the transformation zone and whether abnormal cells are missing must be considered. Cervical secretions (CS) are always present in variable proportions, and when cleaning the cervix, better samples may be obtained. In this study, we analyzed samples obtained with or without cleaning the cervix, and compared their contents in order to determine the sensitivity and specificity of these two methods. Methods: Of 500 patients who underwent cytology and colposcopy, 271 (54.2%) required a second opinion due to a diagnosis of cervical intraepithelial neoplasia (CIN). CS was removed and compared with the clean, second sample (SS) using in both liquid-based cytology. The quality of samples according to the Bethesda System, the presence of CIN, and inflammatory reactions were recorded. The sensitivity and specificity were calculated using biopsy as the gold standard. Results: The SS resulted in a higher proportion of adequate samples being obtained (97.6% vs. 44.8%), and in increased sensitivity (88.2% vs. 58.8%). CIN was detected in the SS 26% more often than in the CS (34 vs. 27 samples), whereas inflammatory reactions were noted more often in the CS (91.4% vs. 74%). Conclusion: Cervical sampling including CS results in lower sensitivity and CIN detection rates, and in more inflammatory reactions. By excluding CS from cervical samples, the sensitivity could be improved and the false negative rate could be reduced.     

Severe complications in a child with achondroplasia and two FGFR3 mutations on the same allele

We describe a unique case of achondroplasia with associated complications, including severe respiratory problems. Molecular analysis of the fibroblast growth factor receptor type 3 (FGFR3) gene in this patient showed the common p.G380R mutation and a second novel p.L377R mutation. An allele-specific PCR demonstrated that these mutations were on the same allele (cis). Both mutations were not present in the parents and appear to have occurred de novo. To our knowledge, this is the first report in the literature on an achondroplasia patient with two FGFR3 mutations on the same allele.     

Computerized preoperative planning for correction of sagittal deformity of the spine

Purpose  

Various methods of preoperative planning have been described for the correction of spinal sagittal deformities. They are reliable on condition that the thoracolumbar spine is totally fused and enable only the simulation of pedicle subtraction osteotomy (PSO). In this study, a new theoretical planning that can be used regardless of the etiology of the deformity and the type of osteotomy is described and assessed.     

Dopaminergic neurons are preferentially sensitive to long-term rotenone toxicity in primary cell culture.

Parkinson's disease (PD) is a chronic neurodegenerative disorder characterized by the death of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and the subsequent decrease of dopamine levels in the striatum. Epidemiological studies indicate environmental pollutants as a causative factor of sporadic PD. Experimental cell culture models have the inherent problem to mimic long-lasting neurodegeneration and to tackle its time-concentration relationship. The present study was designed to investigate the sensitivity of primary dopaminergic neurons to long-term rotenone exposure relevant to PD. Primary cultures prepared from embryonic mouse mesencephala were treated with nanomolar concentrations of rotenone (1, 3, 5, 10nM) on the 6th day in vitro (DIV) for 2, 4 and 6 days. The number of tyrosine hydroxylase immunoreactive (TH(+)) neurons and total hematoxylin-stained nuclei were counted. Astrocyte density was qualitatively evaluated by anti-glial fibrillary acidic protein (anti-GFAP) immunocytochemistry. It was found that dopaminergic neurons were highly sensitive to long-term rotenone treatment. Rotenone in a concentration- and time-dependent manner decreased the number of TH(+) neurons and led to degenerative changes of their morphology. Counting of the total cell number revealed a significant deleterious effect on the overall culture after 6 days of rotenone exposure. However, our study demonstrates a higher sensitivity of dopaminergic neurons to long-term exposure to nanomolar concentrations of rotenone. Other cells in the culture including non-dopaminergic neurons and glia cells appeared less affected compared to dopaminergic neurons.     

Pregnancy following induction of ovulation with pure FSH after suppression of endogenous gonadotropins with subcutaneous Buserelin

Summary Ovarian stimulation in patients with disorders of ovulation or an inadequate luteal phase using human menopausal gonadotropins (hMG) gives a low pregnancy rate with a high incidence of overstimulation and a premature LH surge. In order to overcome these problems, a new approach has been used, namely prior suppression of endogenous gonadotropins with a gonadotropin-releasing-hormone analog (LHRH) and subsequent ovarian stimulation with hMG. We present a case of ovarian stimulation with pure FSH during suppression of endogenous gonadotropins with the LHRH analog Buserelin. A clinical pregnancy was achieved in the first treatment cycle and led us to conclude that follicular development does not depend on LH stimulation. This could be of substantial interest in IVF programs.     

Transillumination technique in difficult intubations in heart surgery

OBJECTIVE: The avoidance of myocardial depression still remains the goal of the management for cardiosurgical patients, also when unexpected difficulties in intubation face the anaesthetist. Therefore the difficult intubation should be managed by a short and easy procedure which provides safe results. To analyse the use of transillumination technique with a lightwand device (Trachlight(R), Laerdale, USA) in case of unexpected difficult intubation is the aim of our report. Methods All cardiosurgical patients (NYHA II - IV) were included from Jan 1998 - Dec 2001. After failure of the first intubation attempt by means of direct laryngoscopy (with non-adjustable vocal cord level) this intubation was qualified as an difficult intubation. In all these cases a lightwand device (Trachlight(R), Laerdale, USA) was applicated. Success, duration of the procedure, blood pressure, heart rate were recorded. Results 195 patients (out of total 7406) who could not be directly intubated by laryngoscopy (vocal cord level and arytenoid cartilage not visible), were classified as a difficult intubation. During the first year 1998 the light guided intubation (LGI) was successful as secondary procedure in 94 %, 3 cases, in which LGI failed the intubation was performed by fiberoptic method or McCoy blade. From 1999 to 2001 all difficult intubation could be managed by light guided intubation. In all cases of unexpected difficult intubation the procedure of the light guided intubation took as less than 3 min. The directly measured arterial blood pressure elevated by 14 % in comparison with the pressure prior to the passage through the larynx. Discussion and Conclusions 1998 after sufficient familiarisation of staff with the light wand device the transillumination technique was introduced as an alternative of using the McCoy blade or of using the fiberoptic method in the case of difficult intubation. Short neck or obesity, which occur as main reasons for intubation problems are surprisingly easy to control by light wand device. Therefore the light guided intubation could be an alternative procedure for unexpected difficult intubation in the setting of adult cardiac anesthesia.     

The bifunctional activity of ubiquinone in lysosomal membranes

Ubiquinone is inhomogenously distributed in subcellular biomembranes. Apart from mitochondria where ubiquinone was demonstrated to exert bioenergetic and pathophysiological functions, unusually high levels of ubiquinone were also reported to exist in Golgi vesicles and lysosomes. In lysosomes the interior differs from other organelles by the low pH-value, which is important not only to arrest proteins but also to ensure optimal activity of hydrolytic enzymes. Since redox-cycling of ubiquinone is associated with the acceptance and release of protons, we assumed that ubiquinone is a part of a redox chain contributing to unilateral proton distribution. A similar function of ubiquinone was earlier suggested by Crane to operate in Golgivesicles. Support for the involvement of ubiquinone in a presumed couple of redox-carriers came from our observation that almost 70% of total lysosomal ubiquinone was in the divalently reduced state. Further reduction was seen in the presence of external NADH. Analysis of the components involved in the transfer of reducing equivalents from cytosolic NADH to ubiquinone revealed the existence of a FAD-containing NADH-dehydrogenase. The latter was found to reduce ubiquinone by means of a b-type cytochrome. Proton translocation into the interior was linked to the activity of the novel lysosomal redox chain. Oxygen was found to be the terminal electron acceptor, thereby also regulating acidification of the lysosomal matrix. In contrast to mitochondrial respiration, oxygen was only trivalently reduced, giving rise to the release of HO^•-radicals. The role of this novel proton-pumping redox chain and the significance of the associated ROS formation has to be elucidated. This revised version was published online in July 2006 with corrections to the Cover Date.     

Neurologic morbidity after herpes simplex virus type 2 meningitis: a retrospective study of 40 patients

In order to study the long-term course after herpes simplex virus type 2 (HSV-2) meningitis and/or myeloradiculitis the records of 40 consecutive patients were studied. During the year following the acute phase, verified or suspected neurologic recurrences were noted in nearly half of the patients: 1 or more episodes of recurring meningitis were noted in 8 patients; new episodes of myelitis or radiculitis in 3; distinct attacks of headache in 4; and diffuse neurologic complaints impairing daily life in 3. Recurring mucocutaneous symptoms were observed in 16 patients. Eleven patients experienced concurrent or separate episodes of recurring mucocutaneous and neurologic symptoms, 7 had neurologic recurrences only and 5 had only mucocutaneous recurrences. As considerable morbidity may result, patients with HSV-2 meningitis and/or myeloradiculitis should be identified by means of thorough history-taking, careful examination and a specific viral diagnosis in order to enable adequate advice and counseling to be provided and to aid decision-making regarding antiviral therapy.